Social Psychiatry and Psychiatric Epidemiology

, Volume 47, Issue 9, pp 1401–1408 | Cite as

The use of coercive measures in adolescent psychiatric inpatient treatment: a nation-wide register study

  • Siponen Ulla
  • Välimäki Maritta
  • Kaltiala-Heino Riittakerttu
Original Paper

Abstract

Purpose

To evaluate the extent and trends in the use of seclusion/restraint in psychiatric inpatient treatment of adolescents aged 12–17 years in Finland.

Methods

The National Hospital Discharge Register data comprising all psychiatric inpatient treatment periods of 12- to 17 year-olds in Finland during the period 1996–2003 was used. Time trends, regional variation and patient characteristics related to the risk of being subjected to seclusion/restraint in psychiatric inpatient treatment are reported.

Results

The average prevalence of use of seclusion and restraint was 1.71/10,000/year over the study period. Use of seclusion/restraint in adolescent psychiatric inpatient care first increased, peaking in 1999–2001, and then decreased. The decrease occurred after stricter legislative control of use of seclusion/restraint was introduced in 2002, despite that involuntary treatment periods did not decrease. Considerable regional variation was seen in the use of seclusion/restraint. A greater proportion of girls than boys were secluded/restrained. Seclusion/restraint was most common in schizophrenia, mood disorders and conduct disorder.

Conclusions

Legislative control had the desired immediate impact on the use of seclusion/restraint in adolescent psychiatric inpatient care. Legislative control is, however, not strong enough to ensure homogenous practices across the country, as there is many-fold regional variation in figures for using seclusion and restraint.

Keywords

Seclusion Restraint Coercion Adolescent psychiatry Health services research 

Notes

Conflict of interest

None.

References

  1. 1.
    Gaskin CJ, Elsom SJ, Happell B (2007) Interventions for reducing the use of seclusion in psychiatric facilities: review of literature. Br J Psychiatry 191:298–303PubMedCrossRefGoogle Scholar
  2. 2.
    Sailas E, Fenton M (2002) Seclusion and restraint for people with serious mental illnesses. Cochrane Database Syst Rev 2: CD001163Google Scholar
  3. 3.
    Steinert T, Lepping P, Bernhardsgütter R, Conca A, Hatling T, Keski-Valkama A, Mayoral F, Whittington R (2010) Incidence of seclusion and restraint in psychiatric hospitals: a literature review and survey of international trends. Soc Psychiatry Psychiatr Epidemiol 45:889–897PubMedCrossRefGoogle Scholar
  4. 4.
    Keski-Valkama A, Sailas E, Eronen M, Koivisto A-M, Lönnqvist J, Kaltiala-Heino R (2007) A 15-year national follow-up: legislation is not enough to reduce the use of seclusion and restraint. Soc Psychiatry Psychiatr Epidemiol 42:747–752PubMedCrossRefGoogle Scholar
  5. 5.
    Salib E, Ahmed AG, Cope M (1998) Practice of seclusion: a five-year retrospective review in north Cheshire. Med Sci Law 38:321–327PubMedGoogle Scholar
  6. 6.
    Crenshaw WB, Cain KA, Francis PS (1997) An updated national survey on seclusion and restraint. Psychiatr Serv 48:395–397PubMedGoogle Scholar
  7. 7.
    Gullick K, McDermott B, Stone P, Gibbon P (2005) Seclusion of children and adolescents: psychopathological and family factors. Int J Ment Health Nurs 14:37–43PubMedCrossRefGoogle Scholar
  8. 8.
    Fryer M, Beech M, Byrne G (2004) Seclusion use with children and adolescents: an Australian experience. Aust NZ J Psychiatry 38:26–33CrossRefGoogle Scholar
  9. 9.
    Donovan A, Plant R, Peller A, Siegel L, Martin A (2003) Two-year trends in the use of seclusion and restraint among psychiatrically hospitalized youths. Psychiatr Serv 54:987–993PubMedCrossRefGoogle Scholar
  10. 10.
    Kaltiala-Heino R (2004) Increase in involuntary psychiatric admission of minors: a register study. Soc Psychiatry Psychiatr Epidemiol 39:53–59PubMedCrossRefGoogle Scholar
  11. 11.
    Siponen U, Välimäki M, Kaivosoja M, Marttunen M, Kaltiala-Heino R (2007) Increase in involuntary psychiatric treatment and child welfare placements in Finland 1996–2003: a nationwide register study. Soc Psychiatry Psychiatr Epidemiol 42:146–152PubMedCrossRefGoogle Scholar
  12. 12.
    Kaltiala-Heino R, Korkeila J, Tuohimäki C, Tuori T, Lehtinen V (2000) Coercion and restrictions in psychiatric inpatient treatment. Eur Psychiatry 15:213–219PubMedCrossRefGoogle Scholar
  13. 13.
    Kaltiala-Heino R, Tuohimäki C, Korkeila J, Lehtinen V (2003) Reasons for using seclusion and restraint in psychiatric inpatient care. Int J Law Psychiatry 26:139–149PubMedCrossRefGoogle Scholar
  14. 14.
    Prinsen EJ, van Delden JJ (2009) Can we justify eliminating coercive measures in psychiatry? J Med Ethics 35:325–328CrossRefGoogle Scholar
  15. 15.
    Pylkkänen K (2003) Care guarantee in adolescent psychiatry. Final report of the NUOTTA project 2003. Rep Ministr Soc Aff Health 2003:13Google Scholar
  16. 16.
    Siponen U, Välimäki M, Kaivosoja M, Marttunen M, Kaltiala-Heino R (2011) A comparison of two hospital districts with low and high figures in the compulsory care of minors: an ecological study. Social Psychiatry Psychiatr Epidemiol (Epub ahead of print)Google Scholar
  17. 17.
    Lay B, Nordt C, Rössler W (2011) Variation in use of coercive measures in psychiatric hospitals. Eur Psychiatry 26:244–251PubMedCrossRefGoogle Scholar
  18. 18.
    Keski-Valkama A, Sailas E, Eronen M, Koivisto AM, Lönnqvist J, Kaltiala-Heino R (2010) Who are the restrained and secluded patients: a 15-year nationwide study. Soc Psychiatry Psychiatric Epidemiol 45:1087–1093CrossRefGoogle Scholar
  19. 19.
    Krakowski M, Czobor P (2004) Gender differences in violent behaviors: relationship to clinical symptoms and psychosocial factors. Am J Psychiatry 161(3):459–465PubMedCrossRefGoogle Scholar
  20. 20.
    Moretti MM, Odgers CL (2002) Aggressive and violent girls: prevalence, profiles and contributing factors. In: Corrado RR, Roesch R, Hart SD, Gierowski JK (eds) Multi-problem violent youth: a foundation for comparative research on needs, interventions and outcomes. IOS Press, Amsterdam, pp 116–129Google Scholar
  21. 21.
    Swanson JW, Swartz MS, Van Dorn RA, Elbogen EB, Wagner HR, Rosenheck RA et al (2006) A national study of violent behavior in persons with schizophrenia. Arch Gen Psychiatry 63(5):490–499PubMedCrossRefGoogle Scholar
  22. 22.
    Kaltiala-Heino R (2010) Involuntary commitment and detainment in adolescent psychiatric inpatient care. Soc Psychiatry Psychiatr Epidemiol 45:785–793PubMedCrossRefGoogle Scholar
  23. 23.
    Link BG, Stueve A, Phelan J (1998) Psychotic symptoms and violent behaviors: probing the components of “threat/control-override” symptoms. Soc Psychiatry Psychiatr Epidemiol 33(S1):S55–S60PubMedCrossRefGoogle Scholar
  24. 24.
    Gammelgård M, Koivisto AM, Eronen M, Kaltiala-Heino R (2010) Violence risk and psychopathology in institutionalised adolescents. J Forensic Psychiatry Psychol 21(6):933–949CrossRefGoogle Scholar
  25. 25.
    Fisher WA (1994) Restraint and seclusion: a review of the literature. Am J Psychiatry 151:1584–1591PubMedGoogle Scholar
  26. 26.
    Joshi P, Capozzoli J, Coyle J (1988) Use of a quiet room on an inpatient unit. J Am Acad Child Adolesc Psychiatry 27:642–644PubMedCrossRefGoogle Scholar
  27. 27.
    Antoinette T, Iynegar S, Puig-Antich J (1990) Is locked seclusion necessary for children under 14? Am J Psychiatry 147:1283–1289PubMedGoogle Scholar
  28. 28.
    Cotton N (1995) Seclusion as therapeutic management: an invited commentary. Am J Orthopsychiatry 65:245–248CrossRefGoogle Scholar
  29. 29.
    Masters KJ, Bellonci C, Bernett W, Arnold V, Beitchman J, Benson RS et al (2002) Practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions, with special reference to seclusion and restraint. J Am Acad Child Adolesc Psychiatry 41(suppl 2):4S–25SGoogle Scholar
  30. 30.
    Barnett SR, dosReis S, Riddle MA (2002) Maryland youth practise improvement committee. Improving the management of acute aggression in state residential and inpatient psychiatric facilities for youths. J Am Acad Child Adolesc Psychiatry 41:897–905PubMedCrossRefGoogle Scholar
  31. 31.
    American Psychiatric Association, American Psychiatric Nursing Association and National Association for Psychiatric Health Systems (2003) Learning from each other. Success stories and ideas for reducing restraint/seclusion in behavioural health. Retrieved March 26 2010 from http://www.naphs.org
  32. 32.
    dosReis S, Barnett S, Love RC, Ridle MA, Maryland Youth Practise Improvement Committee (2003) A guide for managing acute aggressive behavior of youths in residential and inpatient treatment facilities. Psychiatr Serv 54:1357–1363PubMedCrossRefGoogle Scholar
  33. 33.
    Donat D (2003) An analysis of successful efforts to reduce the use of seclusion and restraint at a public psychiatric hospital. Psychiatr Serv 54:1119–1123PubMedCrossRefGoogle Scholar
  34. 34.
    Lebel J, Goldstein R (2005) The economic cost of using restraint and the value added by restraint reduction or elimination. Psychiatr Serv 56(9):1109–1114PubMedCrossRefGoogle Scholar
  35. 35.
    Kaltiala-Heino R, Berg J, Selander M, Työläjärvi M, Kahila K (2007) Aggression management in an adolescent forensic unit. Int J Forensic Ment Health 6:185–196CrossRefGoogle Scholar
  36. 36.
    Sees D (2009) Impact of the health care financing administration regulations on restraint and seclusion usage in the acute psychiatric settings. Arch Psychiatr Nurs 23(4):277–282PubMedCrossRefGoogle Scholar
  37. 37.
    Niveau G (2004) Preventing human rights abuses in psychiatric establishments: the work of the CPT. Eur Psychiatry 19:146–154PubMedCrossRefGoogle Scholar
  38. 38.
    Keski-Valkama A, Sailas E, Eronen M, Koivisto AM, Lönnqvist J, Kaltiala-Heino R (2010) The reasons for using restraint and seclusion in psychiatric inpatient care: a nationwide 15-year study. Nord J Psychiatry 64:136–144PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Siponen Ulla
    • 1
  • Välimäki Maritta
    • 1
    • 2
  • Kaltiala-Heino Riittakerttu
    • 3
    • 4
    • 5
  1. 1.Department of Nursing ScienceUniversity of TurkuTurkuFinland
  2. 2.The Hospital District of Southwest Finland, Turku University HospitalTurkuFinland
  3. 3.Department of Adolescent PsychiatryTampere University HospitalTampereFinland
  4. 4.School of MedicineUniversity of TampereUniversity of TampereFinland
  5. 5.Vanha Vaasa HospitalVaasaFinland

Personalised recommendations